Aortic Valve Repair / Replacement Post Operative Care

Tell any doctor
or dentist who treats you that you have had your valve repaired or replaced.
They may prescribe antibiotics before procedures, especially dental work, to
prevent an infection from settling in your heart.

It is likely that you will be taking Coumadin, an anticoagulant, commonly
called a "blood thinner." Coumadin causes blood to take a longer time to
form a clot.

There are several points you should know about Coumadin:

You will need regular blood tests (prothrombin time) to regulate the
dosage of Coumadin. Your physician will arrange these tests for you.

Look for signs of bleeding while you are taking Coumadin. Notify your
physician if you have:

any abnormal bleeding

red or black bowel movements

pink or red urine

severe headaches, abdominal or lower back pain

faintness or dizziness

red or "coffee ground like" vomitus

excessive bruising

excessive nose bleeds

yellow or jaundice skin

any symptoms that concern you

Take your Coumadin at the same time every day. NEVER make up for a missed
dose by taking double the dose.

Don't take aspirin or any
"over-the-counter" medications without first checking with your physician
as this can cause bleeding while taking Coumadin.

It is a good idea to carry a wallet identification card indicating
that you are taking Coumadin.

General
Post-Operative Instructions
Many questions
arise as to what you should do or should not do after discharge. The
following are answers to the most common concerns and questions.

While the sternum (breastbone) is healing, avoid lifting greater than 10 pounds, or pushing/pulling activities with your arms. The breastbone takes about 6-8 weeks to heal generally.

Showers are permitted but tub baths are discouraged for 4-6 weeks or until your incisions are healed. Avoid extremely hot water which may cause you to feel dizzy or weak. You may gently wash (don't rub) your incision with soap. Do not use creams or lotions on incisions until they are healed.

Avoid driving a car for 4-6 weeks after surgery. Your reaction time will be delayed due to weakness, fatigue, and/or medication. You do not want to risk hitting the steering wheel and re-injuring the sternum. When riding in a car for long distances, stop every 1-2 hours to stretch your legs. This will improve circulation in your legs and help prevent swelling.

Do not cross your legs while lying in bed or sitting. This puts pressure on the veins under the knees and slows blood flow. If your legs or feet swell, you should put them on a chair or stool while sitting.

Sleep the number of hours that you normally slept before your surgery. Do not stay up very late one night and try to "catch-up" the next. However, if you do plan to stay up late, take a nap beforehand.

It is important to space and pace your activities to minimize fatigue. If you feel tired, STOP, and rest for a while. Don't push yourself to finish a task.

A rest period should be taken at least once a day for a few weeks and, initially, preferably twice, morning and afternoon. Napping is not necessary, but resting is. Be sure to dress daily in street clothes. You are on your way to recovery!

Stair climbing is not discouraged. Avoid pulling yourself up with a handrail, and go slowly.

Use your elastic stockings during the day and remove them at night. You should wear the stockings for at least 2 weeks after discharge or more if your ankles are still swollen. The stockings aid blood flow and help reduce swelling in the legs. It is easiest to put the stockings on before you get out of bed in the morning for the day, however most people put them on after a morning shower. They should fit snugly.

You may notice swelling or a lump at the top of your chest incision which could take several months to disappear.

Most patients experience incisional discomfort in the sternum. This discomfort will decrease in time, but may reoccur when there is an adverse change in the weather or when you overextend yourself. Do not hesitate to use pain relieving medication as you need it.

It is important to distinguish incisional discomfort from chest pain (angina) you may have experienced prior to surgery. Contact your physician if you are experiencing chest pain.

If your chest or leg incisions do not appear to be healing (i.e., redness, drainage, swelling, or tenderness is present), notify your physician.

Take your temperature every morning for one week after discharge. Notify your physician if your temperature stays above 100° F for more than a day.

Check your weight every morning for the first two weeks. If you notice a sudden weight gain, notify your physician.

When you are upset, your heart works harder. It is best to anticipate and avoid situations, people, or topics of conversation that make you tense or angry.

Remember that your diet, medications, and exercise are prescribed specifically for you. Do not expect your friend or neighbor who has a heart condition to have the same prescriptions.

Keep a record of your medications and medical history with you when traveling.

Recovering from Open Heart Surgery is a Family Affair

Open
heart surgery is an event that affects the patient, spouse, children, and
significant others. It is similar to the ripple effect in a pond when a
stone is dropped. Many waves occur before the pond eventually calms. In
addition to the physical recovery that the patient undergoes, there is an
emotional aspect of adjustment that the patient, as well as family,
experience.

Facing the possibility of changing one's lifestyle can be quite
overwhelming. Some alterations take place immediately, such as diet changes
and smoking cessation. Other changes may be more gradual, such as building
up to and maintaining an exercise program, or incorporating long term stress
management. Of importance to all those involved is realizing that the
patient does have control in initiating the changes and in maintaining
healthy new habits. This is the patient's responsibility. Spouses, children,
and significant others often struggle with the impossible task of making
sure the patient never deviates off course and stays on the "straight and
narrow'. Remember, others can assist and encourage, but only the patient can
do!

Many lifestyle changes that occur as a result of having open heart
surgery have a direct impact on the entire household. When a patient is
forced to make changes for health reasons, very often all minds start to
think along the same lines. This is especially true for others who might
possibly be predisposed to coronary artery disease. Therefore, if the
recovering patient has stopped smoking, family members who smoke are now
motivated to quit. And when meals now need to be prepared in a heart-healthy
fashion, chances are those who dine together will also be making these
changes out of practicality for the cook resulting from a renewed awareness
of the benefits to the heart.

Recovering from open heart surgery creates temporary role changes and
responsibility shifts among family members. When the recovering patient
returns home, he/she will have temporary physical limitations and
dependencies which the family members compensate. The husband will need to
shop and carry packages for his recovering wife who can neither drive
herself to the store nor lift heavy packages. The son or daughter will have
to mow the lawn and take out the garbage for their recovering father, who
now has to limit exertion while he rebuilds his strength.

Just as the family needs to coordinate efforts in assisting the patient
during his limitation phase, so should they enable him to increase his
independence and regain his level of self reliance. This proves to be a very
delicate balance and can be a cause of friction. Staying informed of the
doctors recommendations on how the patient should progress can minimize the
stress of this transitional period for both the patient and family.

Recovery will be a challenge for the open heart surgery patient and
his/her family. There will be days of high energy and of fatigue,
accomplishments, moments of temptation, feelings of exuberance and even days
of feeling blue or angry, all of which are a part of the physical and
emotional healing process that takes place.

Tips for your continued successful recovery:

Encourage each other to express and discuss your feelings. Open communication can minimize misunderstandings.

Seek support by talking with others who have experienced similar circumstances. Sharing common concern can be reassuring.

Reach out for help. Having to focus on changing several habits can be overwhelming. Behavior modification groups (i.e. Smoke Enders) provide structure as well as the mutual support helpful for success.

Become knowledgeable about your condition.

Be inquisitive, attend lectures, and explore literature. Being informed can reduce anxiety.

Begin and maintain an exercise program for your physical and mental well being. Exercising with others can create added motivation.

If you are feeling emotionally overwhelmed, seek professional advice. A trained counselor can help you to cope more adequately with your concerns. Consult your hospital social worker or physician for this service.

Remember, recovery takes time. All of those involved will adjust
according to their ability to assimilate the lifestyle and role changes
which inevitably take place. Sharing your feelings and discussing ongoing
issues can make for a smoother transition for all. (Return to Top)

Sex
After Surgery

There
is a great deal of pleasurable sexual activity that is not sexual
intercourse. Being near someone, holding, fondling, caressing, are all
activities that enhance closeness and pleasure. Since these activities
require very little energy, you may engage in these anytime after discharge
from the hospital. Many couples find that this expression of love allows
them to return slowly to a full sex life with confidence.

Sexual intercourse requires slightly more energy, therefore a waiting time
of 1-3 weeks is generally recommended. Another consideration will be
position. As the sternum has been cut, a modification may be necessary in
order to prevent injury to the sternum or incisional pain. Exercise will
strengthen the heart and overall physical condition. So as you engage in the
home walking program and witness firsthand increased endurance and
confidence, you will know when you are ready. The energy expenditure for
intercourse is the equivalent of walking briskly or climbing two flights of
stairs. The heart rate rarely rises above 120 beats/minute and blood
pressure elevations are similarly mild and transient.

The person recovering after open heart surgery may be more conscious of
his or her heartbeat, breathing, and muscle tension. This awareness is
normal and is no cause for alarm.

Fear of performance and general depression are two psychological factors
that can greatly reduce sexual interest and capacity. These are considered
normal during convalescence and in most cases disappear within 3 months. If
depression continues after 3-6 months, professional counseling should be
considered.

Various medications may affect sexual drive and/or function. If this
occurs, consult your physician. Often a change in medication or dosage can
remedy the problem. Never stop taking any prescribed medication without your
physician's approval.

Ways to prepare for the resumption of sexual activity:

The first step is to exercise as mentioned above.

The second step is to be tolerant of each others emotions. For a
brief time following open heart surgery, emotions are delicately
balanced and subject to rapid mood swings. Try to keep day to day events
in perspective and remember that a good sense of humor is a good ally.

The third step is to try to adjust mutual sexual expectations.
Emotional response as well as physical responses sometimes make the
resumption of sexual relations fearful and that is normal. Therefore
don't expect too much at first.

Some
general guidelines:

Be relaxed and rested before intercourse. Avoid sex if you are
fatigued or upset.

Choose a position that does not restrict breathing or require
prolonged muscular support.

Maintain a comfortable room temperature and familiar surroundings
and partner.

Speak with your physician if you are experiencing any chest pain,
angina, shortness of breath, rapid heart rate, or extreme fatigue in
relation to sexual activity.

Wait at least 1 hour after a meal or alcoholic beverages before
having sexual activity.